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Initiatives toward Suicide and Self-Harm Prevention: Addressing the Global Imperative

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (31 August 2021) | Viewed by 51139

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Special Issue Editors

Dr. Lisa N. Sharwood

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Guest Editor

1. Black Dog Institute, Faculty of Medicine and Health, University of New South Wales, Sydney 2032, Australia
2. John Walsh Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, St. Leonards, Sydney 2006, Australia
3. School of Engineering and Mechatronics, University of Technology Sydney, Broadway, Sydney 2007, Australia
Interests: traumatic injury; injury outcomes; public health; global burden of disability; mental illness; suicide prevention; record linkage data; injury prevention

Dr. Fiona Shand

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Assistant Guest Editor

Director of Lifespan Research, Black Dog Institute, Sydney, NSW, Australia
Interests: suicide prevention; mental illness; substance use disorder; e-mental health interventions for at-risk populations; Indigenous suicide prevention; health service research

Dr. Jesse Young

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Assistant Guest Editor

1. Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
2. School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
3. National Drug Research Institute, Curtin University, Perth, WA, Australia
Interests: justice health; mental illness; substance use disorder; population health; injury; record linkage data

Special Issue Information

Dear Colleagues,

The annual incidence of mental ill-health episodes in developed nations such as Australia is around 1 in 5 persons; some may experience an acute episode for the first time, related to environmental stressors (such as is currently being seen in the global pandemic of COVID-19), or for reasons of financial, personal or relationship difficulty. It is well documented that many of these individuals do not seek treatment, or if they do, do not receive adequate care. This leads to further physical and mental distress which could have been mitigated with timely, appropriate intervention.

The costs of mental illness (including self-harm and suicide) to the Australian economy have been estimated at around $43 to $51 billion per year, in addition to the estimated $130 billion cost associated with the disparate physical health and reduced life expectancies for individuals living with mental illness. The creeping complexity of mental illness incorporates the same determinants of health that give rise to increased risks of justice system involvement, homelessness, substance use disorder, and social exclusion. All of these factors increase risks of sustaining traumatic injury either intentionally, through self-harm and suicide, or unintentionally, through increased vulnerability and exposure. Premature death in individuals diagnosed with mental illness is often preceded by years of poor health and insufficient access to physical health services compared to the general population.

Suicidal behaviour presents a significant health burden globally, with increasing efforts around the world now focussed on suicide prevention. However, not all initiatives are evidence based or effective. Given the scope, severity, and consistency of the problem of suicide, evidence-based approaches in suicide prevention are vital for an effective impact on a population level, and single intervention approaches are not sufficient.

To that end, we invite your submission to this Special Issue entitled “Suicide Prevention Strategies: Looking toward the Future”, targeted at the highest-quality research and reviews addressing all relevant aspects. Submissions can include systematic reviews, or original and experimental manuscripts that provide evidence to strengthen the global knowledge base in effective suicide prevention strategies.

Assoc. Prof. Fiona Shand
Dr. Lisa N. Sharwood
Dr. Jesse Young
Guest Editors

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

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Published Papers (13 papers)

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15 pages, 1216 KiB

Open AccessArticle

Precarious Suicide Behavior According to Housing Price Gap: A Case Study on South Korea

by Sungik Kang, Hosung Woo and Ja-Hoon Koo

Int. J. Environ. Res. Public Health 2021, 18(18), 9877; https://doi.org/10.3390/ijerph18189877 - 19 Sep 2021

Cited by 2 | Viewed by 2900

Abstract

In 2018, the suicide rate in South Korea was the highest among the Organisation for Economic Co-operation and Development countries, and socioeconomic inequality has intensified. This study analyzes the impact relationship between suicidal impulses and economic inequality in South Korea. This study measures suicidal impulses thoughts National Health Survey Data and economic inequality based on the housing prices gap in the country. The primary analysis results were as follows: First, suicidal impulses were positively associated with the high index of housing price inequality; this correlation has become tight in recent years. Second, it was confirmed that the higher the income level, the higher the correlation between suicidal impulses with the index of housing price inequality. Third, the correlation between housing price inequality with suicidal impulse increased consistently in highly urbanized areas, but the statistical significance was low in non-urban areas. Full article

(This article belongs to the Special Issue Initiatives toward Suicide and Self-Harm Prevention: Addressing the Global Imperative)

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14 pages, 424 KiB

Open AccessArticle

Application of a Scorecard Tool for Assessing and Engaging Media on Responsible Reporting of Suicide-Related News in India

by Lakshmi Vijayakumar, Manisha Shastri, Tanya Nicole Fernandes, Yash Bagra, Aaryaman Pathare, Arpita Patel, Padam Jain, Yesha Merchant, Gregory Armstrong and Soumitra Pathare

Int. J. Environ. Res. Public Health 2021, 18(12), 6206; https://doi.org/10.3390/ijerph18126206 - 8 Jun 2021

Cited by 6 | Viewed by 4154

Abstract

Background: Each year there are more than 800,000 deaths by suicide across the world, while India alone accounts for one third of female suicides and one fourth of male suicides worldwide. Responsible media reporting of suicide is an important suicide prevention intervention at the population level. There is sufficient evidence to show that the way suicide is reported and portrayed in the media can have a significant impact on individuals experiencing suicidal thoughts and behaviors. Recognizing the important role of the media in suicide prevention, the World Health Organization (WHO) issued guidelines for responsible reporting of suicides by the media. The Press Council of India, in 2019 endorsed WHO’s guidelines for media reporting of suicides, however there is no evidence that the Indian media is complying with these guidelines. Methods: To encourage responsible media reporting, we developed a scorecard to assess and rate media reports on suicide. We reviewed several resource documents that contained guidelines on responsible reporting of suicide. After consulting with a team of experts, we arrived at a scorecard that consisted of 10 positive and 10 negative parameters. Results: We applied the scorecard to 1318 reports on suicide from 9 English language newspapers, with the highest readership in India between the dates of 1 April to 30 June 2020. For the articles analyzed, the average positive score across all newspapers was 1.32 and the average negative score was 3.31. Discussion: The scorecard can be a useful tool to assess media reports on suicide and provide metrics for the same. It can facilitate improved monitoring and engagement with media organizations, who can quickly check their own reporting compliance to the WHO guidelines and compare how well they are performing compared to their peers over time. Full article

(This article belongs to the Special Issue Initiatives toward Suicide and Self-Harm Prevention: Addressing the Global Imperative)

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22 pages, 3014 KiB

Open AccessArticle

The Perceived Stigma Reduction Expressed by Young Adults in Response to Suicide Prevention Videos

by Sarah Keller, Vanessa McNeill and Tan Tran

Int. J. Environ. Res. Public Health 2021, 18(12), 6180; https://doi.org/10.3390/ijerph18126180 - 8 Jun 2021

Cited by 5 | Viewed by 3433

Abstract

Evidence indicates that stigma impedes an individual’s chance of seeking professional help for a mental health crisis. Commonly reported aggregate-level results for stigma-reduction efforts obfuscate how much stigma reduction is needed to incur a practically meaningful change within an individual, defined here as an attitudinal shift and openness towards seeking mental health for oneself and/or support for others. When basing conclusions and recommendations about stigma-reducing interventions on aggregate scales, it is unclear how much stigma reduction is needed to incur meaningful change within an individual. We explored the impact of reductions in stigma of help-seeking scores in response to an online suicide prevention video among young adults in the United States, using online surveys to collect qualitative and quantitative data. We compared mean changes in the stigma scores from pre- to post-test (video exposure) of 371 young U.S. adults using standard t-tests and individual level analysis. A separate thematic analysis of free-text responses was also conducted from a smaller, randomly-selected subgroup, capturing individuals’ attitudes towards help-seeking for mental health problems. Great attention was given to participants to ensure that they were in a campus setting where counseling services were available. Four main themes emerged: (1) small changes in stigma scores were associated with individual reports of meaningful reductions in their attitudes towards professional counseling; (2) increased empathy towards victims of suicide and other mental health problems sometimes indicated increased empathy for victims of suicide and decreased openness in professional help; (3) empathy towards victims sometimes took the form of increased scores and grief or sadness, possibly thwarting the potential for help-seeking; and (4) self-reports of decreased stigma were not always associated with increased openness towards help-seeking. Results also indicated that small stigma score charges, not meeting statistical significance, were often associated with increased openness towards seeking help. These findings, discovered using mixed-methods, contribute to the body of literature regarding stigma towards suicide and help-seeking by demonstrating deficits in the aggregate-only analysis of stigma-reducing interventions specifically aimed at suicide prevention. Such individuation in stigma experiences indicates that public education on how to reduce the stigma of help-seeking for suicide prevention needs to consider individual-level analyses for improving target populations. Recommendations for future research include additional studies prior to releasing suicide prevention videos to public forums where they may be seen by individuals without access to help. Full article

(This article belongs to the Special Issue Initiatives toward Suicide and Self-Harm Prevention: Addressing the Global Imperative)

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14 pages, 336 KiB

Open AccessArticle

What Works in Community-Led Suicide Prevention: Perspectives of Wesley LifeForce Network Coordinators

by Lennart Reifels, Amy Morgan, Lay San Too, Marisa Schlichthorst, Michelle Williamson and Helen Jordan

Int. J. Environ. Res. Public Health 2021, 18(11), 6084; https://doi.org/10.3390/ijerph18116084 - 4 Jun 2021

Cited by 3 | Viewed by 2776

Abstract

Community coalitions have been recognised as an important vehicle to advance health promotion and address relevant local health issues in communities, yet little is known about their effectiveness in the field of suicide prevention. The Wesley Lifeforce Suicide Prevention Networks program consists of a national cohort of local community-led suicide prevention networks. This study drew on a nationally representative survey and the perspectives of coordinators of these networks to identify the key factors underpinning positive perceived network member and community outcomes. Survey data were analysed through descriptive statistics and linear regression analyses. Networks typically reported better outcomes for network members and communities if they had been in existence for longer, had a focus on the general community, and had conducted more network meetings and internal processes, as well as specific community-focused activities. Study findings strengthen the evidence base for effective network operations and lend further support to the merit of community coalitions in the field of suicide prevention, with implications for similar initiatives, policymakers, and wider sector stakeholders seeking to address suicide prevention issues at a local community level. Full article

(This article belongs to the Special Issue Initiatives toward Suicide and Self-Harm Prevention: Addressing the Global Imperative)

13 pages, 882 KiB

Open AccessArticle

Gender Differences in the Prevalence of and Factors Related to Non-Suicidal Self-Injury among Middle and High School Students in South Korea

by Jin-Young Jeong and Dong-Hyun Kim

Int. J. Environ. Res. Public Health 2021, 18(11), 5965; https://doi.org/10.3390/ijerph18115965 - 2 Jun 2021

Cited by 22 | Viewed by 3797

Abstract

This study was conducted to estimate the prevalence of non-suicidal self-injury (NSSI)—the most severe mental health problem among South Korean adolescents in 2019. The participants were students from 12 middle and seven high schools in a single city in the metropolitan area in South Korea. A cluster-random sampling method was used—one class per school year at each middle and high schools. Every student in the selected classes was investigated. The final number of selected classes and students were as follows: 36 classes, 1074 students at middle schools; 35 classes, 873 students at high school. Data were obtained using a self-administered online questionnaire. The 12-month prevalence of NSSI was 8.8% among Korean adolescents, 2.85 times higher for female than male students (13.4% vs. 4.7%). For the school grade, the multivariable-adjusted odds ratio [mOR] was 3.89 times (95% confidence interval [CI] 1.35–11.26) higher for the group with the highest school records compared with the middle group for male students, while such pattern was not observed among female students (mOR 1.11, 95% CI 0.54–2.26). The risks for NSSI were higher among female students with lower economic status, compared with those with higher economic status (mOR 4.16, 95% CI 1.43–12.05). In contrast, economic status did not indicate higher risk among male students (mOR 1.43, 95% CI 0.42–4.84). This study suggests that the risk for NSSI among adolescent students may be different according to gender and comprehensive interventions from schools against NSSI may need a gender-sensitive approach in South Korea. Full article

(This article belongs to the Special Issue Initiatives toward Suicide and Self-Harm Prevention: Addressing the Global Imperative)

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13 pages, 458 KiB

Open AccessArticle

Comparative Analysis of Lifetime Suicide Attempts among Mexican Adolescents, over the Past 12 Years

by Rosario Valdez-Santiago, Aremis Villalobos, Luz Arenas-Monreal, Catalina González-Forteza, Alicia Edith Hermosillo-de-la-Torre, Corina Benjet and Fernando A. Wagner

Int. J. Environ. Res. Public Health 2021, 18(10), 5419; https://doi.org/10.3390/ijerph18105419 - 19 May 2021

Cited by 11 | Viewed by 3367

Abstract

Objective. To compare the occurrence of suicide attempts across nationally representative samples of the Mexican adolescent population over the past 12 years, and to analyze its association with sociodemographic, lifestyle and mental-health indicators. Methodology. Data were drawn from the 2006, 2012 and 2018 National Health and Nutrition Surveys (n = 25,056; 21,509; and 17,925 adolescents, respectively). Estimates were based on standardized measurements. Results. The estimated lifetime prevalence rates of suicide attempts were 1.1% in 2006, 2.7% in 2012, and 3.9% in 2018, indicating a 3.4-fold increase. Across the three survey periods, women yielded rates nearly three times higher than men. Lifetime prevalence grew the most among adolescents aged 13–15 years. Compared to the other respondents, the odds of lifetime suicide attempts proved seven times as high for those who had been sexually abused during their childhood, five times as high for those who had been diagnosed with a depressive disorder, three times as high for those who had suffered physical aggression and twice as high for those who had smoked 100+ cigarettes in their lifetimes and those who consumed alcohol. Conclusion: The sharp increase in suicide attempts in Mexico calls for an urgent public-health response via universal and targeted interventions supported by national policy and sustained federal funding. Full article

(This article belongs to the Special Issue Initiatives toward Suicide and Self-Harm Prevention: Addressing the Global Imperative)

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17 pages, 847 KiB

Open AccessArticle

Psychosocial Correlates of Suicidal Behavior among Adolescents under Confinement Due to the COVID-19 Pandemic in Aguascalientes, Mexico: A Cross-Sectional Population Survey

by Alicia Edith Hermosillo-de-la-Torre, Stephania Montserrat Arteaga-de-Luna, Denise Liliana Acevedo-Rojas, Angélica Juárez-Loya, José Alberto Jiménez-Tapia, Francisco Javier Pedroza-Cabrera, Catalina González-Forteza, Manuel Cano and Fernando A. Wagner

Int. J. Environ. Res. Public Health 2021, 18(9), 4977; https://doi.org/10.3390/ijerph18094977 - 7 May 2021

Cited by 39 | Viewed by 6495

Abstract

Background: Suicide and suicidal behaviors were already a global public health problem, producing preventable injuries and deaths. This issue may worsen due to the COVID-19 pandemic and may differentially affect vulnerable groups in the population, including children, adolescents, and young adults. The current study evaluated the association of affective variables (depression, hopelessness, and anxiety), drug use (alcohol, tobacco, and others), emotional intelligence, and attachment with suicidal behaviors. Methods: A state-wide survey included 8033 students (51% female, 49% male; mean age of 16 years) from science and technology high-schools using a standardized questionnaire that was distributed online. Multinomial logistic regression models tested associations between suicidal behaviors and several covariates. The analyses accommodated the complex structure of the sample. Results: Approximately 21% of all students reported a suicidal behavior (11% with a low-lethality suicide attempt, 6% with self-injuries, and 4% with a high-lethality suicide attempt). Variables associated with higher odds of suicidal behavior included: female sex, depression, hopelessness, anxiety, alcohol and tobacco use, childhood trauma, and having to self-rely as issues affecting attachment, and low self-esteem. Security of attachment was associated with lower odds of suicidal behavior. Conclusions: The complexity of suicidal behavior makes it clear that comprehensive programs need to be implemented. Full article

(This article belongs to the Special Issue Initiatives toward Suicide and Self-Harm Prevention: Addressing the Global Imperative)

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18 pages, 3511 KiB

Open AccessArticle

A Qualitative Analysis of Motivators to Participation in Suicide-Focused Research from a Community-Based Australian Sample

by Demee Rheinberger, Fiona Shand, Katherine Mok, Lauren McGillivray, Myfanwy Maple, Alexander Burnett, Lisa N. Sharwood, Nicola A. Chen and Michelle Torok

Int. J. Environ. Res. Public Health 2021, 18(9), 4705; https://doi.org/10.3390/ijerph18094705 - 28 Apr 2021

Cited by 2 | Viewed by 2896

Abstract

Suicide prevention strategies internationally appear to be falling short of making a meaningful impact on global suicide deaths. Increasing the rates of general community participation in suicide research may improve knowledge generalisability as it relates to suicidal behaviour and leads to new suicide prevention approaches. This study aims to explore the motivations of a community-based sample to participate in suicide research. A subsample of the Australian general population took part in an online survey which is part of a multilevel suicide prevention trial. The survey concluded with an optional open-text question asking about peoples’ motivations for participating in the study; 532 participants left a response to this question. These responses were qualitatively analysed using Thematic Network Analysis. Motivations to participate in suicide research were represented by four global themes: altruism, solve systemic problems, lived experience, and personal benefit. Of these themes, three were focused on the benefit of others, while only the final theme articulated motivation to participate that was self-focused. The impact of suicide is felt throughout the wider community. This new understanding of the motivations of community-based samples to participate in suicide research should be used to increase participation rates and reach people who would not normally contribute their voice to suicide research. Full article

(This article belongs to the Special Issue Initiatives toward Suicide and Self-Harm Prevention: Addressing the Global Imperative)

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12 pages, 668 KiB

Open AccessArticle

Method-Specific Suicide Mortality Trends in Australian Men from 1978 to 2017

by Noelia Lucía Martínez-Rives, Bibha Dhungel, Pilar Martin and Stuart Gilmour

Int. J. Environ. Res. Public Health 2021, 18(9), 4557; https://doi.org/10.3390/ijerph18094557 - 25 Apr 2021

Cited by 6 | Viewed by 3104

Abstract

In 2017 Australia saw the highest overall suicide rate in the past 10 years, with male suicide rates three times higher than in women. Since the mid-1980s there have been major changes in suicide epidemiology in Australia with large shifts in method of suicide among both men and women. This study examined method-specific suicide trends in Australian men over the past 40 years by state. Suicide mortality data for the period 1978 to 2017 was obtained from the Australian Institute of Health and Welfare (AIHW) National Mortality Database and log-linear Poisson regression analysis was used to analyse suicide mortality. This study found large differences between states in patterns and trends in suicide mortality from 1978 to 2017. Hanging, gas and firearms were the most common methods of suicide in Australia. We found statistically significant increasing trends in hanging suicide among men in all six states. The study findings highlight the growing concern of hanging-related suicide in all states in Australia since the late 1970s. New suicide prevention strategies focusing on the ubiquity and ease of hanging as a method will be needed in order for Australia to reduce suicide mortality in future. Full article

(This article belongs to the Special Issue Initiatives toward Suicide and Self-Harm Prevention: Addressing the Global Imperative)

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16 pages, 2107 KiB

Open AccessArticle

Measuring Attitudes toward Suicide Prevention among Occupational Staff Frequently Exposed to Suicidal Individuals: Psychometric Evaluation and Validation

by Inga-Lill Ramberg, Sebastian Hökby, Linda Karlsson and Gergö Hadlaczky

Int. J. Environ. Res. Public Health 2021, 18(8), 4001; https://doi.org/10.3390/ijerph18084001 - 10 Apr 2021

Cited by 1 | Viewed by 4006

Abstract

As the attitudes of healthcare staff are thought to influence the quality and effectiveness of interventions targeting patients’ suicide risk, attitudes are often used as an outcome in the evaluation of suicide-preventive training. Due to various problems related to the validity and reliability of commonly used scales, there is a lack of overall agreement on how to measure these attitudes. Confirmatory factor analysis (CFA) was used to cross-validate previously used models and to investigate new models to measure professionals’ attitudes toward work with suicidal individuals and to test the longitudinal stability of the models by analyzing new sets of data. The population in the first study consisted of a heterogenous group of 1350 professionals who managed suicidal individuals relatively frequently. The second study included 640 professionals. The results of the cross-validation of previous models were described and a new questionnaire measuring attitudes toward suicide prevention, suicidal individuals, and organizational-facilitated self-efficacy (OSAQ-12) was presented. The three presented models retained a good fit and were stable over time. Valid and reliable measurement models that measure aspects of attitudes toward suicide are a prerequisite for conducting both cross-sectional and intervention studies. Full article

(This article belongs to the Special Issue Initiatives toward Suicide and Self-Harm Prevention: Addressing the Global Imperative)

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12 pages, 463 KiB

Open AccessArticle

Impact of Violent Experiences and Social Support on R-NSSI Behavior among Middle School Students in China

by Kun Liu, Xueyan Yang and Moye Xin

Int. J. Environ. Res. Public Health 2021, 18(7), 3347; https://doi.org/10.3390/ijerph18073347 - 24 Mar 2021

Cited by 14 | Viewed by 2713

Abstract

Repetitive nonsuicidal self-injury (R-NSSI) is an extreme manifestation of nonsuicidal self-injury (NSSI) behavior that causes bodily harm and emotional and personality disorders. It is a growing concern, especially among adolescents; therefore, this study aims to provide empirical support for effective interventions on R-NSSI behavior among adolescents in China. We used data of about 1180 students from a survey conducted in seven middle schools in Xi’an, China, and applied multiple logistic regression to analyze NSSI and R-NSSI among male and female students, including their influencing factors. We found no significant difference between male and female students’ R-NSSI; however, regarding influencing factors, male students had more violent experiences and less social support than female students. Parental and familial factors played the most prominent role in social support. Social support was found to be a main-effect mechanism in the effect of violent experiences on R-NSSI among male students, whereas the mechanism had both a main effect and a certain buffer effect among female students. R-NSSI was found to be more prevalent among younger children, children with siblings, and those with romantic relationship experiences. We also found that healthy adolescent development involves the participation of families and schools. Health education should be conducted according to the students’ sex and characteristics. Full article

(This article belongs to the Special Issue Initiatives toward Suicide and Self-Harm Prevention: Addressing the Global Imperative)

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12 pages, 3037 KiB

Open AccessArticle

Suicidal Ideation Risk and Socio-Cultural Factors in China: A Longitudinal Study on Social Media from 2010 to 2018

by He Li, Yujin Han, Yunyu Xiao, Xingyun Liu, Ang Li and Tingshao Zhu

Int. J. Environ. Res. Public Health 2021, 18(3), 1098; https://doi.org/10.3390/ijerph18031098 - 26 Jan 2021

Cited by 18 | Viewed by 3950

Abstract

Many studies cited the importance of social factors as protective and risk factors for suicide. However, there is a lack of evidence on the influences of cultural and moral values. This study aims to examine the association between cultural values and suicidal ideation risks detected on an online social media platform. We collected a total of 5.1 billion pieces of Weibo posts from 2010 to 2018 to calculate their suicidal ideation risks as measured by psychache in the Chinese Suicide Dictionary. We calculated the word frequencies of cultural and moral values based on Cultural Value Dictionary and Moral Foundation Dictionary. We collected economic and population data from the China National Bureau of Statistics. Two-way fixed-effect models were performed to analyze the association between culture, economy, and population factors and suicidal ideation risks. The results confirm the relations between high suicidal ideation risk and public concerns of vice under the Chinese context such as harm (β = 0.193, p < 0.01), betrayal (β = 0.096, p < 0.01), and dirty (β = 0.624, p < 0.001). In addition, extremely individualistic or collectivistic values of the public were associated with high suicidal ideation risks. The finding indicated the significant impact of social culture on suicide risk apart from the influence of the social economy and population characteristics. Our evidence informs population-based suicide prevention policymakers that incorporating cultural and moral values can help prevent suicidal ideation in China. Full article

(This article belongs to the Special Issue Initiatives toward Suicide and Self-Harm Prevention: Addressing the Global Imperative)

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9 pages, 286 KiB

Open AccessConcept Paper

Suicide Models and Treatment Models Are Separate Entities. What Does It Mean for Clinical Suicide Prevention?

by Konrad Michel

Int. J. Environ. Res. Public Health 2021, 18(10), 5301; https://doi.org/10.3390/ijerph18105301 - 17 May 2021

Cited by 15 | Viewed by 5921

Abstract

Theoretical models of suicide are based on risk factors associated with suicide, such as psychiatric pathology, genetics, epigenetics, functional brain disorders, and impaired decision making. In current clinical practice, the predominant risk model is the medical model, which posits that treating suicide risk is primarily a matter of treating psychiatric disorders. However, even comprehensive risk factor models cannot overcome the basic problem that, by their nature, they cannot accommodate the suicidal person’s psychological experience of suicidality. Risk factor models do not translate into effective treatment models. Suicide risk is highly personal and fluid, and is related to individual vulnerabilities and to person-specific events triggering suicidal thoughts and actions. Clinicians need treatment models that are meaningful to suicidal patients. Understanding the single person’s suicidality requires a patient-centered approach. Therapeutic interventions that effectively reduce the risk of suicidal behavior have been developed from general principles of psychotherapy. Therapy process factors associated with effective therapies are working alliance, validation of the individual patient’s thoughts and feelings, active treatment engagement. Psychological therapies need patients who are active participants in a collaborative working relationship between therapist and patient. The goal must be to jointly develop a meaningful understanding of the suicidal crisis. In view of the limited personal resources in health care systems it is important that effective therapies are brief and effective. Future research must aim to improve our understanding of the factors involved in effective therapies in order to optimize treatments for individuals at risk. This may also include the integration of biological risk factors in psychological treatment models. Full article

(This article belongs to the Special Issue Initiatives toward Suicide and Self-Harm Prevention: Addressing the Global Imperative)

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